2024 -- S 2345

========

LC005003

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL

MARKET AFFORDABILITY ACT OF 2024

     

     Introduced By: Senators Miller, Ujifusa, DiPalma, Valverde, Lauria, and DiMario

     Date Introduced: February 12, 2024

     Referred To: Senate Finance

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Title 42 of the General Laws entitled "STATE AFFAIRS AND

2

GOVERNMENT" is hereby amended by adding thereto the following chapter:

3

CHAPTER 157.2

4

RHODE ISLAND INDIVIDUAL MARKET AFFORDABILITY ACT OF 2024

5

     42-157.2-1. Short title and purpose.

6

     (a) This chapter shall be known and may be cited as the "Rhode Island Individual Market

7

Affordability Act of 2024."

8

     (b) The purpose of this chapter is to create a state affordability program to reduce out-of-

9

pocket costs for low- and moderate-income consumers enrolled in health insurance coverage

10

through the Rhode Island health benefits exchange.

11

     (c) Nothing in this chapter shall be construed as obligating the state to make general

12

revenue appropriations to support the state affordability program.

13

     42-157.2-2. Definitions.

14

     As used in this chapter:

15

     (1) "Affordability program" means a program to improve affordability for health care or

16

health insurance coverage as implemented by the board established by § 42-157.2-6.

17

     (2) "Assessment" means the health insurance affordability assessment established by § 42-

18

157.2-5.

 

1

     (3) "Board" means the health insurance affordability board established by § 42-157.2-7.

2

     (4) "Commissioner'' means the commissioner of the office of the health insurance

3

commissioner.

4

     (5) "Cost-sharing reduction" means the program set forth in 42 U.S.C. § 18071 by which

5

certain individuals eligible to purchase health insurance coverage through the exchange are entitled

6

to purchase a plan with an adjusted actuarial value to lower out-of-pocket expenses.

7

     (6) "Director" means the director of the Rhode Island health benefits exchange.

8

     (7) "Exchange" means the Rhode Island health benefits exchange established within the

9

department of administration by § 42-157-1.

10

     (8) "Federal poverty line" has the same meaning as "poverty line" as set forth in 42 U.S.C.

11

§ 9902(2).

12

     (9) "Health insurance carrier" or "carrier'' has the same meaning as set forth in § 27-18.5-

13

2.

14

     (10) "Health insurance coverage" has the same meaning as set forth in § 27-18.5-2.

15

     (11) "Household income" has the same meaning as set forth in 26 U.S.C. § 36B(d)(2).

16

     (12) "Individual market" has the same meaning as set forth in § 27-18.5-2.

17

     (13) "Office of the health insurance commissioner" means the entity established by § 42-

18

14.5-1 within the department of business regulation.

19

     (14) "Premium tax credit" means the refundable tax credit available pursuant to assist

20

certain individuals in purchasing health insurance coverage through the exchange.

21

     (15) "Program" means the individual market affordability program established by § 42-

22

157.2-3.

23

     (16) "Program fund" or "fund" means the fund established by § 42-157.2-4.

24

     (17) "State" means the State of Rhode Island.

25

     42-157.2-3. Establishment of the Rhode Island individual market affordability

26

program.

27

     (a) The director is authorized to establish a state-based affordability program, to be known

28

as the Rhode Island individual market affordability program:

29

     (1) To provide for improved affordability for individuals who purchase health insurance

30

coverage through the exchange;

31

     (2) That is consistent with state and federal law.

32

     (b) The program is intended to mitigate the impact of high and rising healthcare costs for

33

low- and middle-income Rhode Islanders who purchase health insurance coverage through the

34

exchange by reducing out-of-pocket costs through expanded affordability programs.

 

LC005003 - Page 2 of 11

1

     (c) The director is authorized, based on recommendations advanced by the board, to

2

implement affordability programs and direct payment to carriers to reduce the cost of health

3

insurance coverage purchased through the exchange, and to improve the actuarial value of health

4

insurance coverage, for individuals determined eligible for state-based subsidies.

5

     (d) The director, in consultation with the commissioner, the secretary of the executive

6

office of health and human services, and the Medicaid director, shall collaborate to identify any

7

federal or other external sources of funding for the program, including funding available through

8

the state's existing Section 1115 Medicaid Demonstration Waiver, the state's existing Section 1332

9

State Innovation Waiver, or new funding available under those authorities or any other authority.

10

     (1) The director is authorized to apply for and obtain any available identified funding for

11

the program.

12

     (2) The secretary of the executive office of health and human services is authorized to apply

13

for, submit, and negotiate any necessary changes to the Medicaid state plan, the state Section 1115

14

Medicaid Demonstration Waiver, or any other necessary authorities in order to facilitate the

15

obtaining of identified funding for the program.

16

     42-157.2-4. Establishment of program fund.

17

     (a) The health insurance individual market affordability fund shall be established to provide

18

funding for the operation and administration of the program in carrying out the purposes of the

19

program under this chapter.

20

     (b) The director is authorized to administer the fund.

21

     (c) The general assembly may appropriate general revenue to support the annual budget

22

for the program.

23

     (d) The fund shall consist of:

24

     (1) The assessment established by § 42-157.2-5;

25

     (2) Any federal funding obtained to improve affordability under this chapter;

26

     (3) Any general revenue appropriated by the general assembly to improve affordability

27

under this chapter; and

28

     (4) Any other money from any other source accepted for the benefit of the fund.

29

     (e) A restricted receipt account shall be established for the fund which may be used for the

30

purposes set forth in this section and shall be exempt from the indirect cost recovery provisions of

31

§ 35-4-27.

32

     42-157.2-5. Health insurance affordability assessment.

33

     Effective for the 2025 calendar year, there is established a health insurance affordability

34

assessment. The assessment amount for 2025 and for each subsequent year shall be set at two

 

LC005003 - Page 3 of 11

1

percent (2%) of premiums collected by health insurance carriers for health insurance plans issued

2

within the state for coverage during the previous calendar year.

3

     42-157.2-6. Utilization of program fund -- Affordability programs.

4

     (a) The director shall allocate the program fund, pursuant to regulations adopted under this

5

chapter:

6

     (1) To provide subsidies to reduce cost sharing for individuals enrolled in health insurance

7

coverage through the exchange who are determined eligible for state subsidies;

8

     (2) To provide payments to carriers to increase the affordability of health insurance on the

9

individual market for individuals who receive federal premium tax credits;

10

     (3) To provide payments to carriers to increase the affordability of health insurance on the

11

individual market who are over the household income limit, as established by federal law, for

12

federal premium tax credits; and

13

     (4) To pay for the actual administrative costs for implementing and administering the

14

program established under this chapter. These actual administrative costs include the following:

15

     (i) The costs to implement the market affordability board established by § 42-157.2-7;

16

     (ii) The actual costs related to implementing and maintaining the assessment established

17

by § 42-157.2-5;

18

     (iii) The costs for conducting analyses necessary to determine the payments to be made to

19

carriers for the purposes described in subsections (a)(l), (a)(2), and (a)(3) of this section; and

20

     (iv) Any other costs which accrue to the state traceable to the operation of this program.

21

     (b) The program fund shall be allocated as the director, pursuant to recommendations

22

established by the board, determines is best in the interest of advancing consumer affordability,

23

with the following limitations:

24

     (1) The director shall appropriate no less than fifty percent (50%) of the program fund

25

toward the subsidies to reduce cost sharing established pursuant to subsection (a)(l) of this section;

26

     (2) The director shall appropriate no more of the program fund toward the carrier payments

27

established pursuant to subsection (a)(3) of this section than are appropriated to the carrier

28

payments established pursuant to subsection (a)(2) of this section.

29

     42-157.2-7. Individual market affordability board.

30

     (a) There is hereby created the individual market affordability board, which is responsible

31

for issuing recommendations to the director for the specific terms of the affordability programs

32

established in § 42-157.2-6.

33

     (b) The board consists of the following voting members:

34

     (1) The director of the exchange or designee;

 

LC005003 - Page 4 of 11

1

     (2) The commissioner of the office of the health insurance commissioner or designee;

2

     (3) Eleven (11) additional members as follows:

3

     (i) One member employed by a carrier;

4

     (ii) One member who is a representative of a statewide association of health benefit plans;

5

     (iii) One member representing primary care healthcare providers who does not represent a

6

carrier;

7

     (iv) One member who represents a healthcare advocacy organization;

8

     (v) One member who is a representative of a business that purchases or otherwise provides

9

health insurance coverage for its employees;

10

     (vi) One member who represents a hospital;

11

     (vii) Five (5) members who are consumers of healthcare who are not representatives or

12

employees of a hospital, carrier, or other healthcare industry entity. To the extent possible, the

13

governor shall ensure that the consumer members of the board are individuals who lack affordable

14

offers of coverage from their employers and who otherwise struggle to afford to purchase health

15

insurance or who struggle to afford to pay for their healthcare.

16

     (c) The members under subsection (b)(3) of this section shall be appointed by the governor

17

and submitted by the governor to the senate, who may within twelve (12) legislative days confirm

18

or reject that appointment. If the senate shall fail for twelve (12) legislative days after the

19

submission to confirm the appointment, the governor shall submit another appointment and so on

20

in like manner until the senate shall confirm the person named by the governor; however, terms of

21

current members of the board of review shall not be altered by this chapter.

22

     (d) To the extent possible, the governor shall attempt to appoint board members who reflect

23

the diversity of the state with regard to race, ethnicity, immigration status, income, wealth,

24

disability, and geography.

25

     (e) The term of office of the members of the board appointed by the governor is four (4)

26

years, and those members may serve no more than two (2) four (4) year terms

27

     (f) In order to ensure staggered terms of office, the initial term of office of the members of

28

the board is:

29

     (1) Two (2) years for the members appointed pursuant to subsections (b)(3)(ii), (b)(3)(iii),

30

and (b)(3)(iv) of this section and for three (3) of the members appointed pursuant to subsection

31

(b)(3)(vii) of this section; and

32

     (2) Four (4) years for the members appointed pursuant to subsections (b)(3)(ii), (b)(3)(iv),

33

and (b)(3)(vi) of this section and for two (2) of the members appointed pursuant to subsection

34

(b)(3)(vii) of this section.

 

LC005003 - Page 5 of 11

1

     (g) Members of the board appointed by the governor serve at the pleasure of the governor

2

and may be removed by the governor.

3

     (h) In the case of a vacancy on the board while the senate is in session, the governor shall

4

appoint a replacement subject to the provisions of subsection (c) of this section. A member who is

5

so appointed to fill a vacancy shall serve the remainder of the unexpired term of the member whose

6

vacancy is being filled.

7

     (i) In the case of a vacancy on the board while the senate is not in session, the governor

8

shall appoint a replacement who shall hold office until the beginning of the next session of the

9

senate.

10

     (j) Members of the board may be reimbursed for actual and necessary expenses, including

11

any required dependent care and dependent or attendant travel, food, and lodging, while engaged

12

in the performance of official duties of the board.

13

     (k) The board shall meet as often as necessary to carry out its duties.

14

     (l) The board is authorized to recommend, for approval and establishment by the director

15

by rule:

16

     (1) The timing and methodology for assessing and collecting the assessment established by

17

§ 42-157.2-5;

18

     (2) The distribution of program fund revenues allocated for carrier payments and for

19

subsidies in a manner that best improves affordability for subsidized populations;

20

     (3) The parameters, including income limits, for implementing the program and for

21

identifying subsidized populations, including:

22

     (i) The coverage required under state-subsidized individual health coverage plans, which

23

coverage shall maximize affordability for qualified individuals;

24

     (ii) The criteria and procedures for determining whether an individual is a qualified

25

individual eligible to enroll in a state-subsidized individual health coverage plan; and

26

     (iii) The appropriate balance of investment into the subsidies to reduce cost-sharing

27

established in § 42-157.2-6(a)(1) and the premium assistance established in §§ 42-157.2-6(a)(2)

28

and 42-157.2-6(a)(3).

29

     42-157.2-8. Rules and regulations.

30

     (a) The director may promulgate regulations as necessary to carry out the purposes of this

31

chapter.

32

     (b) In establishing regulations relating to the parameters of the program, the director shall

33

consider the recommendations of the board and shall explain in writing the reasons for any

34

deviation from the recommendations of the board.

 

LC005003 - Page 6 of 11

1

     SECTION 2. Section 35-4-27 of the General Laws in Chapter 35-4 entitled "State Funds"

2

is hereby amended to read as follows:

3

     35-4-27. Indirect cost recoveries on restricted receipt accounts.

4

     Indirect cost recoveries of ten percent (10%) of cash receipts shall be transferred from all

5

restricted-receipt accounts, to be recorded as general revenues in the general fund. However, there

6

shall be no transfer from cash receipts with restrictions received exclusively: (1) From contributions

7

from nonprofit charitable organizations; (2) From the assessment of indirect cost-recovery rates on

8

federal grant funds; or (3) Through transfers from state agencies to the department of administration

9

for the payment of debt service. These indirect cost recoveries shall be applied to all accounts,

10

unless prohibited by federal law or regulation, court order, or court settlement. The following

11

restricted receipt accounts shall not be subject to the provisions of this section:

12

     Executive Office of Health and Human Services

13

     Organ Transplant Fund

14

     HIV Care Grant Drug Rebates

15

     Health System Transformation Project

16

     Rhode Island Statewide Opioid Abatement Account

17

     HCBS Support-ARPA

18

     HCBS Admin Support-ARPA

19

     Department of Human Services

20

     Veterans’ home — Restricted account

21

     Veterans’ home — Resident benefits

22

     Pharmaceutical Rebates Account

23

     Demand Side Management Grants

24

     Veteran’s Cemetery Memorial Fund

25

     Donations — New Veterans’ Home Construction

26

     Department of Health

27

     Pandemic medications and equipment account

28

     Miscellaneous Donations/Grants from Non-Profits

29

     State Loan Repayment Match

30

     Healthcare Information Technology

31

     Department of Behavioral Healthcare, Developmental Disabilities and Hospitals

32

     Eleanor Slater non-Medicaid third-party payor account

33

     Hospital Medicare Part D Receipts

34

     RICLAS Group Home Operations

 

LC005003 - Page 7 of 11

1

     Commission on the Deaf and Hard of Hearing

2

     Emergency and public communication access account

3

     Department of Environmental Management

4

     National heritage revolving fund

5

     Environmental response fund II

6

     Underground storage tanks registration fees

7

     De Coppet Estate Fund

8

     Rhode Island Historical Preservation and Heritage Commission

9

     Historic preservation revolving loan fund

10

     Historic Preservation loan fund — Interest revenue

11

     Department of Public Safety

12

     E-911 Uniform Emergency Telephone System

13

     Forfeited property — Retained

14

     Forfeitures — Federal

15

     Forfeited property — Gambling

16

     Donation — Polygraph and Law Enforcement Training

17

     Rhode Island State Firefighter’s League Training Account

18

     Fire Academy Training Fees Account

19

     Attorney General

20

     Forfeiture of property

21

     Federal forfeitures

22

     Attorney General multi-state account

23

     Forfeited property — Gambling

24

     Department of Administration

25

     OER Reconciliation Funding

26

     Health Insurance Individual Market Affordability Fund

27

     Health Insurance Market Integrity Fund

28

     RI Health Benefits Exchange

29

     Information Technology restricted receipt account

30

     Restore and replacement — Insurance coverage

31

     Convention Center Authority rental payments

32

     Investment Receipts — TANS

33

     OPEB System Restricted Receipt Account

34

     Car Rental Tax/Surcharge-Warwick Share

 

LC005003 - Page 8 of 11

1

     Grants Management Administration

2

     RGGI-Executive Climate Change Coordinating Council Projects

3

     Executive Office of Commerce

4

     Housing Resources Commission Restricted Account

5

     Housing Production Fund

6

     Department of Revenue

7

     DMV Modernization Project

8

     Jobs Tax Credit Redemption Fund

9

     Legislature

10

     Audit of federal assisted programs

11

     Department of Children, Youth and Families

12

     Children’s Trust Accounts — SSI

13

     Military Staff

14

     RI Military Family Relief Fund

15

     RI National Guard Counterdrug Program

16

     Treasury

17

     Admin. Expenses — State Retirement System

18

     Retirement — Treasury Investment Options

19

     Defined Contribution — Administration - RR

20

     Violent Crimes Compensation — Refunds

21

     Treasury Research Fellowship

22

     Business Regulation

23

     Banking Division Reimbursement Account

24

     Office of the Health Insurance Commissioner Reimbursement Account

25

     Securities Division Reimbursement Account

26

     Commercial Licensing and Racing and Athletics Division Reimbursement Account

27

     Insurance Division Reimbursement Account

28

     Historic Preservation Tax Credit Account

29

     Marijuana Trust Fund

30

     Social Equity Assistance Fund

31

     Judiciary

32

     Arbitration Fund Restricted Receipt Account

33

     Third-Party Grants

34

     RI Judiciary Technology Surcharge Account

 

LC005003 - Page 9 of 11

1

     Department of Elementary and Secondary Education

2

     Statewide Student Transportation Services Account

3

     School for the Deaf Fee-for-Service Account

4

     School for the Deaf — School Breakfast and Lunch Program

5

     Davies Career and Technical School Local Education Aid Account

6

     Davies — National School Breakfast & Lunch Program

7

     School Construction Services

8

     Office of the Postsecondary Commissioner

9

     Higher Education and Industry Center

10

     IGT STEM Scholarships

11

     Department of Labor and Training

12

     Job Development Fund

13

     Rhode Island Council on the Arts

14

     Governors’ Portrait Donation Fund

15

     Statewide records management system account

16

     SECTION 3. This act shall take effect upon passage.

========

LC005003

========

 

LC005003 - Page 10 of 11

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL

MARKET AFFORDABILITY ACT OF 2024

***

1

     This act would create the Rhode Island Individual Market Affordability Act of 2024 to help

2

reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health

3

insurance exchanges.

4

     This act would take effect upon passage.

========

LC005003

========

 

LC005003 - Page 11 of 11